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危重症患者建模:初学者指南。

Modeling for critically ill patients: An introduction for beginners.

作者信息

Lafont Emmanuel, Urien Saik, Salem Joe-Elie, Heming Nicholas, Faisy Christophe

机构信息

Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France.

Centre d'Investigation Clinique-0991 INSERM, Université Paris Descartes Sorbonne Paris Cité, Paris, France.

出版信息

J Crit Care. 2015 Dec;30(6):1287-94. doi: 10.1016/j.jcrc.2015.09.002. Epub 2015 Sep 4.

Abstract

Models are mathematical tools used to describe real-world features. Therapeutic interventions in the field of critical care medicine may easily be translated into such models. Indeed, numerous variables influencing drug pharmacokinetics and pharmacodynamics are systematically documented in the intensive care unit over time. Organ failure, fluid shifts, other drug administration, and renal replacement therapy may cause changes in physiological values, such as body weight and composition, temperature, serum protein levels, arterial pH, and renal or hepatic function. Trials assessing the efficacy and safety of novel drugs usually exclude critically ill patients, and guidelines regarding drug dosage rarely apply to such patients. Modeling in the critically ill may allow physicians to inform decisions related to therapeutic interventions, particularly relating to infectious diseases. However, few clinicians are familiar with these methods. Here, we present a current overview of population pharmacokinetic and pharmacodynamic models applicable in critically ill patients aimed at nonspecialists and then emphazize recent potential of modeling for optimizing treatments and care in the intensive care unit.

摘要

模型是用于描述现实世界特征的数学工具。重症监护医学领域的治疗干预措施可以很容易地转化为这样的模型。事实上,随着时间的推移,重症监护病房中系统记录了许多影响药物药代动力学和药效学的变量。器官衰竭、液体转移、其他药物给药以及肾脏替代治疗可能会导致生理值的变化,如体重和组成、体温、血清蛋白水平、动脉pH值以及肾功能或肝功能。评估新药疗效和安全性的试验通常会排除重症患者,而且关于药物剂量的指南很少适用于此类患者。对重症患者进行建模可以让医生为与治疗干预相关的决策提供依据,尤其是与传染病相关的决策。然而,很少有临床医生熟悉这些方法。在此,我们针对非专业人士介绍适用于重症患者的群体药代动力学和药效学模型的当前概述,然后强调建模在优化重症监护病房治疗和护理方面的最新潜力。

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